Thank you for your interest in BMN. In order to apply for participation with BMN you must submit all the necessary information. Please refer to the Provider Checklist to assure all appropriate information is completed and submitted. The credentialing process will take approximately 60-90 days following receipt of a fully completed application. All applications are reviewed by the Credentialing Committee for final approval once all information is received. You will only be considered participating with BMN when an original signed copy of the contract is received by the BMN Credentialing Department and verified. If you see BMN members prior to your effective date, claims will either be denied or processed at the out of network rate if authorization was obtained. If this occurs, we will not be able to backdate your agreement.
PROVIDER CHECKLIST (.doc file)
PHYSICIAN APPLICATION FOR PARTICIPATION (.doc file)
INDIVIDUAL PROVIDER CONTRACT (.doc file)
INDIVIDUAL PROVIDER QUESTIONS (.doc file)
MALPRACTICE QUESTIONAIRE (.doc file)
APPLICATION FOR APPROVED PROVIDER STATUS (.doc file)
BMN PROVIDER MANUAL (Adobe Acrobat PDF file)
Please make note of this critical information:
If you practice at more than one location, please list every location on your application. You will not be considered participating at locations not indicated on the application.
The billing address on your application is where you would like your checks mailed.
You must provide emergency coverage during non-working hours and vacations. Please refer to your BMN Provider Manual for specific requirements.
Your application will only be considered complete when employment dates include your month and year of employment.
If you have any questions or would like to arrange an orientation, please call our Provider Relations Department at 859-224-2022. We look forward to working with you and including you as a BMN Participating Provider.
